Provider Demographics
NPI:1396728358
Name:TUTTLE, JOHN P JR (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P
Last Name:TUTTLE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:160 N EAGLE CREEK
Mailing Address - Street 2:STE 301
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509
Mailing Address - Country:US
Mailing Address - Phone:859-263-1300
Mailing Address - Fax:859-263-4395
Practice Address - Street 1:160 N EAGLE CREEK
Practice Address - Street 2:STE 301
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509
Practice Address - Country:US
Practice Address - Phone:859-263-1300
Practice Address - Fax:859-263-4395
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY19237208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64192370Medicaid
KY000000047525OtherBCBS
KY106698OtherUMWA
KY64192370Medicaid
KY0544801Medicare ID - Type Unspecified
KY1297201Medicare ID - Type Unspecified